This study was aimed at evaluating the accuracy, diagnostic and prognostic values of vaginal ultrasound as compared to abdominal ultra sound in women with vaginal bleeding in early pregnancy. A prospective study of 196 women consecutively were admitted to Northern Area Armed Forces Hospital, Saudi Arabia, with vaginal bleeding and provisionally diagnosed as threatened abortion or suspected ectopic pregnancy. Both transabdominal and vaginal ultrasound examinations were done to all cases and the results were compared to the clinical pregnancy outcome and statistically analyzed. Fifteen non pregnant cases were excluded from the study. Among 181 women of the study, 111 cases (16.3%) had clinically intact pregnancy. Vaginal US diagnosed an intrauterine pregnancy with fetal pole and cardiac activity in 111 cases at first examination while abdominal US reported that in 97 cases only, the difference was statistically significant. Anenibryonic pregnancy was suspected in 38 cases by abdominal US, while vaginal US detected fetal pole in 15 out of these cases and diagnosed anembryonic pregnancy in 23 cases (P